Device for providing fluid communication with a hollow viscus at the skin surface

ABSTRACT

The invention concerns a device for providing fluid communication with a hollow viscus at the skin surface. Said device, which comprises a tube integral at its ends with intravisceral ( 8 ) and cutaneous ( 6 ) support flanges, is characterized in that the tube consists of two parts ( 2,4 ) integral with a respective flange ( 6, 8 ), mounted axialy mobile for their relative but not spontaneously reversible displacement, the tube part ( 4 ) integral with the intravisceral flange ( 8 ), comprising external locking means ( 10, 12, 26 ) enabling the practitioner to perform said length on the basis of the cumulated thickness of the patient&#39;s walls through which it passes.

The invention comes under the field of medical instrumentation andconcerns a device for inosculation of a hollow organ to the skin.

There is a known medical technique for inosculation of a hollow organ tothe skin. This technique can be used for various organs such as thestomach, colon, small intestine or the bladder and uses a devicedesigned to provide communication between the outside of the body andthe inside of the organ. Generally speaking this kind of devicecomprises principally a transparietal tube with elements at each end,such as or similar to collars, that press respectively against theinside wall of the organ and the outer surface of the skin: thesecollars are termed respectively intravisceral and skin collars.

These devices can be divided into two types, the first being described,for example, by U.S. Pat. No. 4,344,435 (AUBIN), U.S. Pat. No. 5,374,254(BUMA) and U.S. Pat. No. 5,484,420 (RUSSO), for which the distal end ofthe transparietal tube possesses a shoulder forming the intravisceralcollar, with the other end of the tube designed to protrude from thepatient's body and shaped to take the skin collar on the outside,whether this is screwed on (U.S. Pat. No. 4,344,435), clipped on (U.S.Pat. No. 5,374,254) or hard push fitted (U.S. Pat. No. 5,484,420), forexample. These devices are fitted on the patient either by introducingthe tube via the oesophagus until the proximal end of the tube emergesfrom an incision in the patient's skin (U.S. Pat. No. 5,374,254) and(U.S. Pat. No. 5,484,420), or by making an incision in the patient'sbody large enough to allow the intravisceral collar to be introduced(U.S. Pat. No. 4,344,435).

The disadvantage with this first type of device is that surgery andanaesthesia are necessary for them to be installed. In addition they aremore particularly designed to work with a specific fitting installedpermanently for the whole period of treatment, and are uncomfortable forthe patient notably because they protrude from the body at all times.

This is the reason why a second type of device was developed, theso-called “button”, where almost the whole length of the tube lieswithin the wall of the body to avoid the discomfort of any protrusion.With most of these devices an opening is first made in the patient'sbody and allowed to heal, after which the intravisceral collar, theshape of which can be altered sufficiently to pass through the openingeasily, can be introduced directly from the outside. The practitioneralters the shape of the intravisceral collar when installing the button,notably using a pusher that can be inserted inside the tube. Finally ashutter is often provided to close the transparietal tube when not inuse. This type of device is described notably in patents GB2169808(HABERMAN) and U.S. Pat. No. 4,325,513 (NAWASH) and also in patent U.S.Pat. No. 5,374,254 referred to above, that has an arrangement totransform the first type of device into the second type, by cutting thetube after installation and closing it with a shutter.

A more general problem posed by the above-mentioned inosculation deviceslies in the fact that the cumulated thickness of fascia crossed variesfrom one patient to another, and also according to where the device isinstalled on the patient, and even for the same place and same patientfrom one point in time to another; for example, in the case ofgastrostomy when the patient gains weight during treatment this resultsin the abdominal wall growing thicker thus rendering inadequate thebutton installed at the outset.

Note that this problem is solved when devices of the first type areinstalled on the patient, thanks to the fact that the tube on which theskin collar is installed protrudes from the skin so that the collar canbe adjusted as required on the patient, and even for devices U.S. Pat.No. 4,344,435 and U.S. Pat. No. 5,484,420, for which during treatmentthe screwed or sliding connection of the collar on the tube can beadjusted and thus allow changes in the distance separating the twocollars one from the other as required.

In order to overcome this problem for devices of the second type, setsof buttons have been proposed where the respective length of the tubevaries, so that the practitioner chooses the one most suited to the casein hand. However this answer is not totally satisfactory because it mayhappen that none of the buttons available in the set has a tube lengthcorresponding exactly to what is needed.

Buttons have also been proposed in which the collar that holds the tubeagainst the inside wall of the organ and the shape of which can bemodified, is balloon shaped to allow for a relative change in thedistance separating the two collars one from the other. However inpractice it has been found that the balloon, that is inflated withnormal saline, tends to rupture especially if the patient movesabruptly, such as for example when coughing or when straining with theabdominal muscles due to constipation.

Finally there was another proposal, notably with patent GB2169808(HABERMAN), to have a sliding fit for the intravisceral collar on thetransparietal tube, so that when the button is installed theintravisceral collar can be brought more or less close to the skincollar according to the patient in question, by means of traction on theintravisceral collar using pull threads. However, although this answeravoids the need of having to place a large number of collars in a set atthe practitioners disposal, it does not allow the distance between thecollars to be adjusted during treatment, notably to allow for thepatient's weight gain. This function that is adjustable only when thedevice is installed on the patient is highlighted by the fact that thethreads that are used to hold the intravisceral collar are designed tobe either broken down by the gastric juices or to be resorbable. Finallyit should be noted that contradictory functions are required of themeans of connection between the intravisceral collar and the tube,because this connection has to be both rigid enough for satisfactorystability of the device on the patient and yet allow for slippage whenthe position of the intravisceral collar needs to be adjusted.

Generally speaking it can be seen that none of the devices of the firstnor of the second type of device described above has any means ofadjusting the distance separating the intravisceral and skin collarsduring treatment, except for the configuration in which thetransparietal tube protrudes from the patient's body to receive the skincollar and which is not comfortable for the patient. In other words, thesecond type of device, the so-called buttons, do not possess the saidmeans of adjustment except for by using the same method as the firsttype of device, i.e. making the tube protrude from the patient's body,in which case this second type no longer complies with the criteria ofcomfort that prompted their design.

The device presented with this invention is a device for inosculation ofa hollow organ to the skin, along the same lines as the second type ofdevice described above, i.e. the so-called button, comprising atransparietal tube the ends of which are attached to collars that holdthe tube respectively against the internal wall of the organ(intravisceral collar) and against the outside surface of the skin (skincollar), with the intravisceral collar designed so that its shape can bechanged by the practitioner using notably a pusher, to allow it to passinside the organ directly from outside the patient's body. Note thatwith these button type devices the axial dimension lies within that ofthe two intravisceral and skin collars in order to be comfortable forthe patient. For example the intravisceral collar forms the base of ahollow body, the shape of which is changed by the practitioner using apusher that is introduced inside the tube, with the said hollow bodycomprising lateral openings so that liquids can pass through the liquidstube between the organ and the outside.

The purpose of the present invention is to offer a device of the typedescribed above that can be installed and adapted for a given patient,according to the thickness of the walls involved, whilst ensuring thatthe patient's comfort is not affected by an awkward protrusion of thetube outside his body.

With the present invention, and based on the analysis above thatcontributes to the inventive approach to this invention, a device of thetype described above comprises a transparietal tube made up of at leasttwo parts, each attached respectively to the intravisceral and to theskin collar. These parts of the transparietal tube are fitted so as tobe mobile for the relative change in axial position in a fashion that isnot spontaneously reversible. The so-called distal part of the tube thatis attached to the intravisceral collar has means of rendering itimmobile working from the outside to the inside of the tube, so that thepractitioner can make the said change in position. These arrangementsare such that the practitioner can adapt the length of the tube in bothdirections, according to the cumulated thickness of the fascia crossedin the patient, both at the time and after installation of the tube onthe patient, and such that the variation in length of the tube is takenup in the thickness of the patient's fascia that it crosses, that is tosay in other terms that the variation in the length of tube, notablywith respect to lengthening, does not change the initial distance itprotruded from the patient's body.

The result of these arrangements is that a variation in the distancebetween the intravisceral and skin retention collars is now possible,including after installation of the device on the patient, with the saidvariation being obtained by a deliberate procedure carried out by thepractitioner and having no adverse effect, neither on the reliability ofthe device in place, nor on how comfortable it is for the patient.

It should be understood that according to various variations similar atthis general stage of the invention, the said two proximal and distalparts of the transparietal tube are fitted so as to be mobile in coaxialfashion, either one upon the other or again each relative to anintermediary body.

In the case that the intravisceral collar is designed to have its shapechanged by the practitioner using a pusher that is introduced inside thetube, the distal part of the tube is best designed in order to enable itto be gripped by the pusher to render it immobile, with this aspect ofthe design being for example of the bayonet type in the event thatmobility of the parts of the tube relies upon sliding, or again by a noncircular type of nesting fit for the pusher via the axial opening of thedistal part of the tube, in the event that the mobility of the parts ofthe tube relies upon a screw action. These arrangements enable thepractitioner to adapt the length of transparietal tube using the pusher,at least the initially when the tube is installed on the patient.

It should be understood that a pusher comprising arrangements that arecomplementary to those of the distal part of the tube for the saidimmobilisation of the latter, are part of the device covered by theinvention.

The relative mobility between the two parts of the transparietal tube ispreferably obtained by a screwing movement. The distal part of the tubeis for example designed with a non circular axial opening that forms thesaid nesting organ, so that it can be immobilised in the rotationaldirection by the practitioner using a specific tool. This tool can beintroduced into the said axial opening of the distal part of the tube,and comprises at least one area of complementary cross-section.

In the preferred form for constructing the invention, the distal andproximal parts of the transparietal tube are connected one to the otherby screwing, and advantage is taken of the pusher used to change theshape of the intravisceral collar to immobilise the distal part of thetube in the rotational direction. To this end the pusher, or a specifictool of the type described above, comprises for example a non circularsection between its two ends designed to traverse the axial opening ofcomplementary shape in the distal part of the tube.

With another approach to the invention, the transparietal tube is“telescopic”. By “telescopic” should be understood in general thecapacity conferred upon the transparietal tube to change its axialdimension. The tube comprises at least two end parts, each respectivelyattached to the intravisceral and skin collars, that are mobile in anaxial direction one relative to the other in order to enable the lengthof the tube to be varied. The distal part at least, if not both parts ofthe tube, can be rendered immobile from the outside, notably using atool designed to grip the distal part of the tube to enable thepractitioner to change the length of the tube, in both directions, afterinstalling the device on the patient.

It will be more easy to understand the invention and the detailsconcerning it in the description that is going to be made of a preferredform of construction, by referring to the drawings on the appendedsheet, in which:

FIG. 1 is a diagrammatic view along the axis, of a device using a firstform of construction for the invention, where the shape of theintravisceral collar is being changed by a pusher,

FIG. 2 is an axial view of a device according to a second type ofconstruction for the invention, and is the preferred type,

FIG. 3 is a partial transverse section view of the device illustrated inthe previous figure.

On these drawings, a device for inosculation of a hollow organ to theskin comprises principally a tube in two parts 2 and 4, each of theseparts 2 and 4 being attached to a retention collar, 6 and 8,respectively against the internal wall of the organ for the distal part4 of the tube, and against the external surface of the skin for theproximal part 2 of the tube. The two parts 2 and 4 or the tube aremobile in an axial direction one relative to the other, with thepossibility of rendering the distal part 4 of the tube immobile from theoutside in order to enable the practitioner to vary the length of tube2, 4, including when the device has been installed on the patient.

Note that a variation in the distance d separating the collars 6 and 8one from the other is absorbed by a corresponding variation in thecumulated thickness of the fascia 1 of the patient crossed by tube 2, 4,with any variation in the said distance d inducing consequently asimultaneous variation of the length of the tube 2, 4 lying between thetwo collars 6 and 8.

On the variation illustrated in FIG. 1, the relative mobility betweenparts 2 and 4 of the tube is obtained by parts 2 and 4 sliding axiallyone relative to the other. Immobilisation of the distal part 4 of thetube is obtained by means of a “bayonet” device 10, 12, with slots 10being provided on the distal part 4 of the tube to allow the latter tobe held by a specific tool 14 provided with lugs 12.

On the variation illustrated in FIG. 2 the said relative mobilitybetween parts 2 and 4 of the tube is obtained by screwing, by means ofthe tapping 26, with parts 2 and 4 composing the transparietal tubebeing preferably two in number and being screwed one into the other.

Immobilisation of the distal part 4 of the tube is obtained by means ofpusher 16 generally used by the practitioner to push the intravisceralcollar 8 out of shape when installing the device on a patient.

By referring to FIG. 3, it will be noted that immobilisation in therotational direction of the distal part 4 of the tube is obtained thanksto the non circular shape of the axial opening 18 of the distal part 4of, the latter being traversed by an area of the pusher 18 having across-section of complementary shape.

It will be understood that having the transparietal tube in two parts 2and 4 as illustrated in FIG. 2 is a preference only, and that inequivalent manner the transparietal tube could include an intermediatepart in addition, such as 20 on the example illustrated in FIG. 1,without escaping the general rule of the invention described.

The device covered by the invention is preferably provided, in similarfashion to previous devices for this purpose, with a spontaneouslyclosing valve 22 on the distal end of the tube, and a movable shutter 24on the proximal end of the tube. Note also the presence as usual in thiscontext, of lateral openings 28 made in the hollow body formingintravisceral collar 8.

Note also that immobilisation of the proximal part 2 of the tube can beobtained using the skin collar 6, that can be easily gripped fromoutside.

In addition, the distal part 4 of the tube can be held to advantage fromthe inside of the transparietal tube using a removable instrument, suchas 14 or 16 in the manner illustrated, to enable the distal part 4 ofthe tube to be held immobile by the practitioner without the said tool14 or 16 protruding unpleasantly from the patient's body on a permanentbasis.

As an indication, the proportional variation in the distance separatingthe two collars one from the other is of the order of 0.5 to 1 times theminimal length of the tube, depending on the size of the latter. Forexample, for a tube with minimum length 1 cm, the maximum length of thetube will be about 1.5 cm; for a tube measuring a minimum length of 3cm, the maximum length of the tube will be about 6 cm.

Note finally that the applications for the device covered by theinvention are not limited to human surgery, but can be used also forveterinary surgery.

1. Device for inosculation of a hollow organ to the skin, of the type ofdevice comprising a transparietal tube, ends of which are attached tocollars (6, 8) holding the tube, respectively, against the internal wallof the organ (intravisceral collar 8) and against the outside surface ofthe skin (skin collar 6), with the intravisceral collar (8) beingconstructed so that its shape can be changed by the practitioner toallow the intravisceral collar (8) to pass inside the organ directlyfrom the outside of the patient's body, with the followingcharacteristics: The transparietal tube comprises at least two parts (2,4), each attached to a collar respectively intravisceral (8) and skin(6), the said parts (2, 4) of the tube being fitted so that they aremobile for relative changes axial in position that are not spontaneouslyreversible, the said distal part (4) of the tube, attached to theintravisceral coller (8), comprising means of immobilisation (10, 12,26) that can be used from the outside towards the inside of the tube toenable the practitioner to make the said changes in position; Such thatthe practitioner can adapt the length of the tube (2, 4), in bothdirections, according to the cumulated thickness of the fascia (1) ofthe patient crossed, both at the time and after the tube (2, 4) isinstalled on the patient, and such that the variation in the length ofthe tube is taken up inside the thickness of the fascia (1) of thepatient that it crosses; The relative mobility between the two parts (2,4) of the transparietal tube is obtained by screwing (26), with thedistal part (4) of the tube being provided with a non circular axialopening (18) that constitutes a nesting organ, in order for it to berendered immobile in the rotational direction by the practitioner usinga specific tool (16), that can be introduced inside the said axialopening (18) and that comprises at least one area of complementarycross-section.
 2. Device according to claim 1, with the followingcharacteristics: the transpariental tube (2, 4) is “telescopic” andcomprises at least two end parts (2, 4) making up the said distal (4)and proximal (2) parts of the tube.
 3. Device according to claim 2, withthe following characteristics: the distal (4) and proximal (2) parts ofthe tube are connected one to the other by screwing (26).
 4. Deviceaccording to claim 1, with the following characteristics: the relativemobility between the parts (2, 4) of the tube is obtained by the parts(2, 4) sliding axially one relative to the other, with the distal part(4) of the tube being rendered immobile by means of a “bayonet” device(10, 12), with slots (10) being provided in the distal part (4) of thetube in order to allow the latter to be gripped by a specific tool (14)provided with lugs (12).
 5. Device for inosculation of a hollow organ tothe skin, of the type of device comprising a transparietal tube, ends ofwhich are attached to collars (6, 8) holding the tube, respectively,against the internal wall of the organ (intravisceral collar 8) andagainst the outside surface of the skin (skin collar 6), with theintravisceral collar (8) being constructed so that its shape can bechanged by the practitioner to allow the intravisceral collar (8) topass inside the organ directly from the outside of the patient's body,with the following characteristics: The transparietal tube comprises atleast two parts (2, 4), each attached to a collar respectivelyintravisceral (8) and skin (6), the said parts (2, 4) of the tube beingfitted so that they are mobile for relative changes axial in positionthat are not spontaneously reversible, the said distal part (4) of thetube, attached to the intravisceral coller (8), comprising means ofimmobilisation (10, 12, 26) that can be used from the outside towardsthe inside of the tube to enable the practitioner to make the saidchanges in position; Such that the practitioner can adapt the length ofthe tube (2, 4), in both directions, according to the cumulatedthickness of the fascia (1) of the patient crossed, both at the time andafter the tube (2, 4) is installed on the patient, and such that thevariation in the length of the tube is taken up inside the thickness ofthe fascia (1) of the patient that it crosses, where a shape of theintravisceral collar (8) can be changed by the practitioner by means ofa pusher (16) that can be introduced inside the tube (2, 4), with thefollowing characteristics: The distal part (4) of the tube is speciallydesigned to enable it to be gripped by the pusher (16) in order torender it immobile, Such that the practitioner can adapt the length oftransparietal tube (2, 4) using the pusher (16) at least initially whenthe tube (2, 4) is installed on the patient.
 6. Device according toclaim 5, with the following characteristics: The pusher (16) comprisesbetween its two ends a non circular section designed to traverse theaxial opening (18) of complementary shape in the distal part (4), inorder to render the distal part (4) immobile in the rotationaldirection.
 7. A device for inosculation of a hollow organ to the skin,comprising a first part (2) of a transparietal tube having a first endand a second end; a second part (4) of the transparietal tube having afirst end and a second end; a skin collar (6) attached to and holdingthe first end of the first part (2) of the transparietal tube against anoutside surface of a skin; an intravisceral collar (8) attached to andholding the first end of the second part (4) of the transparietal tubeagainst an internal wall of the hollow organ, wherein the intravisceralcollar (8) is constructed such that a shape of the intravisceral collar(8) is changeable by the practitioner to allow the intravisceral collar(8) to pass inside the organ directly from the outside of the patient'sbody; wherein the first part (2) of the transparietal tube and thesecond part (4) of the transparietal tube are fitted so that they aremobile axial for relative changes in position that are not spontaneouslyreversible, wherein the second part (4) of the tube is attached to theintravisceral collar (8); an adjustment arrangement (10, 12, 26) thatengageable from the outside towards the inside of the transparietal tubeto enable a practitioner to make changes of a relative position of thefirst part (2) of the transparietal tube relative to the second part (4)of the transparietal tube such as to enable the practitioner to increaseor to decrease a length of the transparietal tube according to acumulated thickness of a fascia (1) of a patient crossed, both at a timeof installation of the transparietal tube and after the transparietaltube has been installed on the patient, and wherein a change in thelength of the transparietal tube is taken up inside the thickness of thefascia (1) of the patient crossed by the transparietal tube, wherein arelative mobility between the first part (2) of the transparietal tubeand the second part (4) of the transparietal tube is obtained by thefirst part (2) of the transparietal tube and the second part (4) of thetransparietal tube (4) sliding axially one relative to the other,wherein the second part (4) of the transparietal tube is renderedimmobile by means of a “bayonet” device (10, 12), and wherein slots (10)are furnished in the second part (4) of the transparietal tube in orderto allow the transparietal tube to be gripped by a specific tool (14)provided with lugs (12).
 8. The device according to claim 7, wherein thetransparietal tube is “telescopic” and comprises the first part (2) andthe second part (4) making up a proximal part (2) and a distal part (4)of the transparietal tube.
 9. The device according to claim 8, whereinthe distal part (4) and the proximal part (2) of the transparietal tubeare connected one to the other by screwing (26).
 10. A device forinosculation of a hollow organ to the skin, comprising a first part (2)of a transparietal tube having a first end and a second end; a secondpart (4) of the transparietal tube having a first end and a second end;a skin collar (6) attached to and holding the first end of the firstpart (2) of the transparietal tube against an outside surface of a skin;an intravisceral collar (8) attached to and holding the first end of thesecond part (4) of the transparietal tube against an internal wall ofthe hollow organ, wherein the intravisceral collar (8) is constructedsuch that a shape of the intravisceral collar (8) is changeable by thepractitioner to allow the intravisceral collar (8) to pass inside theorgan directly from the outside of the patient's body; wherein the firstpart (2) of the transparietal tube and the second part (4) of thetransparietal tube are fitted so that they are mobile axial for relativechanges in position that are not spontaneously reversible, wherein thesecond part (4) of the tube is attached to the intravisceral collar (8);an adjustment arrangement (10, 12, 26) that engageable from the outsidetowards the inside of the transparietal tube to enable a practitioner tomake changes of a relative position of the first part (2) of thetransparietal tube relative to the second part (4) of the transparietaltube such as to enable the practitioner to increase or to decrease alength of the transparietal tube according to a cumulated thickness of afascia (1) of a patient crossed, both at a time of installation of thetransparietal tube and after the transparietal tube has been installedon the patient, and wherein a change in the length of the transparietaltube is taken up inside the thickness of the fascia (1) of the patientcrossed by the transparietal tube, wherein a shape of the intravisceralcollar (8) is changeable by the practitioner by means of a pusher (16),wherein the pusher is introduceable inside the transparietal tube,wherein the second part (4) of the transparietal tube is constructed toenable the transparietal tube to be gripped by the pusher (16) in orderto render the transparietal tube immobile for allowing the practitionerto adapt the length of the transparietal tube using the pusher (16) atleast initially when the transparietal tube is installed on the patient.11. The device according to claim 10, wherein the pusher (16) comprisesa non circular section between two ends of the pusher (16), wherein thenon-circular section is constructed to traverse an axial opening (18) ofcomplementary shape in the second part (4) of the transparietal tube, inorder to render the second part (4) of the transparietal tube immobilein a rotational direction.
 12. The device according to claim 10, whereina relative mobility between the first part (2) of the transparietal tubeand the second part (4) of the transparietal tube is obtained by thefirst part (2) of the transparietal tube and the second part (4) of thetransparietal tube (4) sliding axially one relative to the other,wherein the second part (4) of the transparietal tube is renderedimmobile by means of a “bayonet” device (10, 12), and wherein slots (10)are furnished in the second part (4) of the transparietal tube in orderto allow the transparietal tube to be gripped by a specific tool (14)provided with lugs (12).
 13. A device for inosculation of a hollow organto the skin, comprising a first part (2) of a transparietal tube havinga first end and a second end; a second part (4) of the transparietaltube having a first end and a second end; a skin collar (6) attached toand holding the first end of the first part (2) of the transparietaltube against an outside surface of a skin; an intravisceral collar (8)attached to and holding the first end of the second part (4) of thetransparietal tube against an internal wall of the hollow organ, whereinthe intravisceral collar (8) is constructed such that a shape of theintravisceral collar (8) is changeable by the practitioner to allow theintravisceral collar (8) to pass inside the organ directly from theoutside of the patient's body; wherein the first part (2) of thetransparietal tube and the second part (4) of the transparietal tube arefitted so that they are mobile axial for relative changes in positionthat are not spontaneously reversible, wherein the second part (4) ofthe tube is attached to the intravisceral collar (8); an adjustmentarrangement (10, 12, 26) that engageable from the outside towards theinside of the transparietal tube to enable a practitioner to makechanges of a relative position of the first part (2) of thetransparietal tube relative to the second part (4) of the transparietaltube such as to enable the practitioner to increase or to decrease alength of the transparietal tube according to a cumulated thickness of afascia (1) of a patient crossed, both at a time of installation of thetransparietal tube and after the transparietal tube has been installedon the patient, and wherein a change in the length of the transparietaltube is taken up inside the thickness of the fascia (1) of the patientcrossed by the transparietal tube, wherein a relative mobility betweenthe first part (2) of the transparietal tube and the second part (4) ofthe transparietal tube is obtained by screwing (26), wherein the secondpart (4) of the transparietal tube is furnished with a non circularaxial opening (18) that constitutes a nesting organ, in order for thetransparietal tube to be rendered immobile in a rotational direction bythe practitioner using a pusher (16), which pusher (16) can beintroduced inside the said axial opening (18) and which pusher comprisesat least one area of complementary cross-section.
 14. The deviceaccording to claim 13, wherein a relative mobility between the firstpart (2) of the transparietal tube and the second part (4) of thetransparietal tube is obtained by the first part (2) of thetransparietal tube and the second part (4) of the transparietal tube (4)sliding axially one relative to the other, wherein the second part (4)of the transparietal tube is rendered immobile by means of a “bayonet”device (10, 12), and wherein slots (10) are furnished in the second part(4) of the transparietal tube in order to allow the transparietal tubeto be gripped by a specific tool (14) provided with lugs (12).
 15. Adevice for inosculation of a hollow organ to the skin, comprising afirst part (2) of a transparietal tube having a first end and a secondend; a second part (4) of the transparietal tube having a first end anda second end, wherein the first part (2) of the transparietal tube andthe second part (4) of the transparietal tube are fitted to each otherfor allowing to induce a relative shifting in an axial direction of thefirst part (2) of the transparietal tube relative to the second part (4)of the transparietal tube such that the shifting is not spontaneouslyreversible; a skin collar (6) attached to and holding the first end ofthe first part (2) of the transparietal tube against an outside surfaceof a skin; an intravisceral collar (8) attached to and holding the firstend of the second part (4) of the transparietal tube against theinternal wall of a hollow organ, wherein the intravisceral collar (8) isconstructed such that a shape of the intravisceral collar (8) iselastically deformable to allow the intravisceral collar (8) to passinside the hollow organ directly from an outside of a patient's body; abayonet device (10, 12) having slots (10) furnished on the second part(4) of the transparietal tube, wherein the bayonet device (10, 12) isengageable from the outside towards the inside of the transparietal tubeto enable a making of changes of a relative position of the first part(2) of the transparietal tube relative to the second part (4) of thetransparietal tube such as to enable an increase or a decrease a lengthof the transparietal tube according to a cumulated thickness of a fascia(1) of a patient crossed, both at a time of installation of thetransparietal tube and after the transparietal tube has been installedon the patient, and wherein a change in the length of the transparietaltube is taken up inside the thickness of the fascia (1) of the patientcrossed by the transparietal tube; slots (10) furnished in the secondpart (4) of the transparietal tube in order to allow the transparietaltube to be gripped by a specific tool (14) provided with lugs (12),wherein a relative mobility between the first part (2) of thetransparietal tube and the second part (4) of the transparietal tube isobtained by the first part (2) of the transparietal tube and the secondpart (4) of the transparietal tube (4) sliding axially one relative tothe other, wherein the second part (4) of the transparietal tube isrendered immobile by means of the “bayonet” device (10, 12).
 16. Thedevice according to claim 15, further comprising an intermediate part(20) of the transparietal tube disposed between the first part of thetransparietal tube and the second part (4) of the transparietal tube.17. A device for inosculation of a hollow organ to the skin, comprisinga first part (2) of a transparietal tube having a first end and a secondend; a second part (4) of the transparietal tube having a first end anda second end, wherein the first part (2) of the transparietal tube andthe second part (4) of the transparietal tube are fitted to each otherfor allowing to induce a relative shifting in an axial direction of thefirst part (2) of the transparietal tube relative to the second part (4)of the transparietal tube such that the shifting is not spontaneouslyreversible; a skin collar (6) attached to and holding the first end ofthe first part (2) of the transparietal tube against an outside surfaceof a skin; an intravisceral collar (8) attached to and holding the firstend of the second part (4) of the transparietal tube against theinternal wall of a hollow organ, wherein the intravisceral collar (8) isconstructed such that a shape of the intravisceral collar (8) iselastically deformable to allow the intravisceral collar (8) to passinside the hollow organ directly from an outside of a patient's body; abayonet device (10, 12) having slots (10) furnished on the second part(4) of the transparietal tube, wherein the bayonet device (10, 12) isengageable from the outside towards the inside of the transparietal tubeto enable a making of changes of a relative position of the first part(2) of the transparietal tube relative to the second part (4) of thetransparietal tube such as to enable an increase or a decrease a lengthof the transparietal tube according to a cumulated thickness of a fascia(1) of a patient crossed, both at a time of installation of thetransparietal tube and after the transparietal tube has been installedon the patient, and wherein a change in the length of the transparietaltube is taken up inside the thickness of the fascia (1) of the patientcrossed by the transparietal tube, wherein the intravisceral collar (8)is shaped like an elastic bottle, wherein the shape of the elasticbottle is changeable by means of a pusher (16), wherein the pusher isintroduceable inside the transparietal tube, wherein the second part (4)of the transparietal tube is constructed to enable the transparietaltube to be gripped by the pusher (16) in order to render thetransparietal tube immobile for allowing the practitioner to adapt thelength of transparietal tube using the pusher (16) at least initiallywhen the transparietal tube is installed on the patient.
 18. The deviceaccording to claim 17 further comprising a noncircular axial opening(18) disposed in the second part (4) of the transparietal tube, whereinthe pusher (16) comprises a non circular section between two ends of thepusher (16), wherein the non-circular section is constructed to traversethe axial opening (18) of complementary shape in the second part (4) ofthe transparietal tube, in order to render the second part (4) of thetransparietal tube immobile in a rotational direction.
 19. The deviceaccording to claim 17, further comprising slots (10) furnished in thesecond part (4) of the transparietal tube in order to allow thetransparietal tube to be gripped by a specific tool (14) provided withlugs (12), wherein a relative mobility between the first part (2) of thetransparietal tube and the second part (4) of the transparietal tube isobtained by the first part (2) of the transparietal tube and the secondpart (4) of the transparietal tube (4) sliding axially one relative tothe other, wherein the second part (4) of the transparietal tube isrendered immobile by means of the “bayonet” device (10, 12).
 20. Thedevice according to claim 17, further comprising an intermediate part(20) of the transparietal tube disposed between the first part of thetransparietal tube and the second part (4) of the transparietal tube.21. A device for inosculation of a hollow organ to the skin, comprisinga first part (2) of a transparietal tube having a first end and a secondend; a second part (4) of the transparietal tube having a first end anda second end, wherein the first part (2) of the transparietal tube andthe second part (4) of the transparietal tube are fitted to each otherfor allowing to induce a relative shifting in an axial direction of thefirst part (2) of the transparietal tube relative to the second part (4)of the transparietal tube such that the shifting is not spontaneouslyreversible; a skin collar (6) attached to and holding the first end ofthe first part (2) of the transparietal tube against an outside surfaceof a skin; a intravisceral collar (8) attached to and holding the firstend of the second part (4) of the transparietal tube against theinternal wall of a hollow organ, wherein the intravisceral collar (8) isconstructed such that a shape of the intravisceral collar (8) iselastically deformable to allow the intravisceral collar (8) to passinside the hollow organ directly from an outside of a patient's body; ascrew connection and tapping (26) furnished on the first part (2) of thetransparietal tube and on the second part (4) of the transparietal tube,wherein the screw connection (26) is engageable from the outside towardsthe inside of the transparietal tube to enable a making of changes of arelative position of the first part (2) of the transparietal tuberelative to the second part (4) of the transparietal tube such as toenable an increase or a decrease a length of the transparietal tubeaccording to a cumulated thickness of a fascia (1) of a patient crossed,both at a time of installation of the transparietal tube and after thetransparietal tube has been installed on the patient, and wherein achange in the length of the transparietal tube is taken up inside thethickness of the fascia (1) of the patient crossed by the transparietaltube, wherein a relative mobility between the first part (2) of thetransparietal tube and the second part (4) of the transparietal tube isobtained by screwing the screw connection and tapping (26), wherein thesecond part (4) of the transparietal tube is furnished with a noncircular axial opening (18) that constitutes a nesting organ, in orderfor the transparietal tube to be rendered immobile in a rotationaldirection by the practitioner using a pusher (16), which pusher (16) canbe introduced inside the said non circular axial opening (18) and whichpusher comprises at least one area of complementary cross-section. 22.The device according to claim 21 further comprising a spontaneouslyclosing valve (22) disposed on the first end of the second part (4) ofthe transparietal tube; a movable shutter disposed on the first end ofthe first part (4) of the transparietal tube.
 23. A kit for inosculationof a hollow organ to the skin, comprising a first part (2) of atransparietal tube having a first end and a second end; a second part(4) of the transparietal tube having a first end and a second end,wherein the first part (2) of the transparietal tube and the second part(4) of the transparietal tube are fitted to each other for allowing toinduce a relative shifting in an axial direction of the first part (2)of the transparietal tube relative to the second part (4) of thetransparietal tube such that the shifting is not spontaneouslyreversible; a skin collar (6) attached to and holding the first end ofthe first part (2) of the transparietal tube against an outside surfaceof a skin; an intravisceral collar (8) attached to and holding the firstend of the second part (4) of the transparietal tube against theinternal wall of a hollow organ, wherein the intravisceral collar (8) isconstructed such that a shape of the intravisceral collar (8) iselastically deformable to allow the intravisceral collar (8) to passinside the hollow organ directly from an outside of a patient's body; anaxial opening (18) having a non circular section and disposed in thesecond part (4) of the transparietal tube; a pusher (16) having a firstend and having a second end and including a non circular section betweenthe first end and the second end of the pusher (16), wherein thenon-circular section is constructed to traverse the axial opening (18)of complementary shape in the second part (4) of the transparietal tube,in order to render the second part (4) of the transparietal tubeimmobile in a rotational direction, wherein a shape of the intravisceralcollar (8) is changeable by means of the pusher (16), wherein the pusheris introduceable inside the transparietal tube, wherein the second part(4) of the transparietal tube is constructed to enable the transparietaltube to be gripped by the pusher (16) in order to render thetransparietal tube immobile for allowing to adapt the length oftransparietal tube using the pusher (16) at least initially when thetransparietal tube is installed on the patient; a screw connection andtapping (26) furnished on the first part (2) of the transparietal tubeand on the second part (4) of the transparietal tube, wherein the screwconnection (26) is engageable from the outside towards the inside of thetransparietal tube to enable a making of changes of a relative positionof the first part (2) of the transparietal tube relative to the secondpart (4) of the transparietal tube such as to enable an increase or adecrease a length of the transparietal tube according to a cumulatedthickness of a fascia (1) of a patient crossed, both at a time ofinstallation of the transparietal tube and after the transparietal tubehas been installed on the patient, and wherein a change in the length ofthe transparietal tube is taken up inside the thickness of the fascia(1) of the patient crossed by the transparietal tube.
 24. A method forinosculating of a hollow organ to the skin, comprising the followingsteps: furnishing a first part (2) of a transparietal tube having afirst end and a second end; furnishing a second part (4) of thetransparietal tube having a first end and a second end; fitting thefirst part (2) of the transparietal tube and the second part (4) of thetransparietal tube to each other for allowing to induce a relativeshifting in an axial direction of the first part (2) of thetransparietal tube relative to the second part (4) of the transparietaltube such that the shifting is not spontaneously reversible; attaching askin collar (6) to and holding the first end of the first part (2) ofthe transparietal tube against an outside surface of a skin; attachingan intravisceral collar (8) to and holding the first end of the secondpart (4) of the transparietal tube against the internal wall of a holloworgan, wherein the intravisceral collar (8) is constructed such that ashape of the intravisceral collar (8) is elastically deformable to allowthe intravisceral collar (8) to pass inside the hollow organ directlyfrom an outside of a patient's body installing the transparietal tube onthe patient; installing the transparietal tube on the patient;furnishing an axial opening (18) having a non circular section in thesecond part (4) of the transparietal tube; furnishing a pusher (16)having a first end and having a second end; including a non circularsection between the first end and the second end of the pusher (16);constructing the non-circular section to be able to traverse the axialopening (18) of complementary shape in the second part (4) of thetransparietal tube, in order to render the second part (4) of thetransparietal tube immobile in a rotational direction; introducing thepusher (16) inside the transparietal tube; changing a shape of theintravisceral collar (8) by means of the pusher (16); constructing thesecond part (4) of the transparietal tube to enable the transparietaltube to be gripped by the pusher (16); gripping the transparietal tubewith the pusher; rendering the transparietal tube immobile for allowingto adapt the length of the transparietal tube using the pusher (16);furnishing a screw connection and tapping (26) on the first part (2) ofthe transparietal tube and on the second part (4) of the transparietaltube; engaging the screw connection (26) from the outside towards theinside of the transparietal tube; screwing the first part (2) of thetransparietal tube relative to the second part (4) of the transparietaltube; making changes of a relative position of the first part (2) of thetransparietal tube relative to the second part (4) of the transparietaltube such as to enable an increase or a decrease a length of thetransparietal tube according to a cumulated thickness of a fascia (1) ofa patient crossed, both at a time of installation of the transparietaltube and after the transparietal tube has been installed on the patient;taking up a change in the length of the transparietal tube inside thethickness of the fascia (1) of the patient crossed by the transparietaltube.
 25. The method for inosculating of a hollow organ to the skin,according to claim 24 further comprising the following steps: furnishingthe first part (2) of the transparietal tube telescopic relative to thesecond part (4) of the transparietal tube; obtaining immobilization ofthe second part (4) of the transparietal tube by means of the pusher(16); pushing the intravisceral collar (8) out of shape when installingthe transparietal tube on the patient.
 26. The method for inosculatingof a hollow organ to the skin, according to claim 24 further comprisingthe following steps: furnishing a spontaneous closing valve (22)disposed on a first end of the second part (4) of the transparietaltube; moving a movable shutter (24) disposed at the first end of thefirst part of the transparietal tube; forming the intravisceral collar(8) as a hollow body; furnishing lateral openings (28) to the hollowbody; gripping the skin collar (6) from the outside; immobilizing thefirst part (2) of the transparietal tube.